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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by babak on June 29, 2002, at 13:31:12
Hi Everyone
For some reason I can’t find any trace of my previous postings on this subject.
Basically I didn’t respond to 45mg of Mirtazapine and 375 mg of Effexor over a period of ten days. I tried increasing the Mirtazapine but it didn’t help and flared up my tinnitus which has now back down to its normal level.
Mirtazapine on its own worked for about four weeks but then it fizzled out. I tried Lithium to augment its effect but it was of no use.
My doctor says that this combination is the strongest available and ECT is the only other suggestion he can come up with. But I neither work nor have insurance cover and the cost is just too much for me. Instead he has put me on 45mg of Mirtazapine and 75mg of Effexor XL with the view to increase the Effexor dose gradually. I don’t think this is going to work but I can’t propose an alternative either.
I feel that Mirtazapine is still doing some good as it has completely stopped the anxiety part of my condition. It is the depression part which is refusing to go over the threshold. As to Effexor, it helps me with my aggression and irritability even at very low doses. However my response to it does not change much at higher doses. At 375mg I feel exactly the same as I would on 37.5mg apart from additional muscle tension and tiredness at high doses. Anhedonia is the real problem. I just can not be bothered with anything. I can’t concentrate and if I am pushed I become irritable. I have no libido what so ever and don’t enjoy anything. I spend most of my time alone at home continuously zapping channels on the TV. I know this is not right and feel frustrated inside. It feels like some sort of block in my head. When I first started Mirtazapine the block just dissolved on the morning of the fourth day in matter of minutes but after four weeks it crept back slowly over two weeks or so. It sounds mad but I can almost pin point the block inside my head. It feels like knot on the left hand side of my brain. If I weren’t so numb I would probably commit suicide out of frustration.
I have tried Reboxetine which caused unbearable kidney pains. I was on Prozac for the initial five years but then it stopped helping with my anger and so I switched Effexor. Within eighteen months I started to loose my libido but I was working then and it didn’t bother me that much. However after six years my marriage broke down and my company went bankrupt after the dot COM crash. This was almost a year ago.
My question is: is anyone else out there who didn’t respond to this combination and have they found an alternative.
Thanks
Babak
Posted by fairnymph on July 7, 2002, at 12:10:48
In reply to Mirtazapine Effexor, posted by babak on June 29, 2002, at 13:31:12
What pyschiatric disorder do you suffer from, depression? Or more?
Have you considered gving wellbutrin a try?
Also, regarding Effexor, 10 days of treatment (especially considering you have to taper onto it, or at least you should) should not be nearly enough for you to start noticing any improvement. I would think you would need at least 3 weeks, if not even longer...
You can't give Effexor more time, though, because you can't afford it?
You say prozac was working well for you for a while, have you considered other SSRIs?
good luck with all this....keep working at it!
~fairnymph
Posted by babak on July 10, 2002, at 2:21:29
In reply to Re: Mirtazapine Effexor, posted by fairnymph on July 7, 2002, at 12:10:48
No one has actually diagnosed it as anything. I have been suffering from depression and anxiety for the last 12 years following a major breakdown.
No I haven’t tried Wellburtin and this is one thing which I am thinking of giving a go before Olanzapine.
Regarding Effexor as I said, I have been taking Effexor for the last six years now; in doses ranging from 37.5 every other day to 375 every day. Despite what every one says I have noticed the difference in matter of few days. I am not talking about the full effect but “the difference”.
What I don’t understand is that why my psychiatrist has put me on 75mg when not only I wasn’t responding to 375mg (10 days excluding two weeks titration) nor did I show any signs of Serotonin Syndrome.
I can afford the medication but not ECT becasue we have national health service in UK. Therefore most treatments are avaialable for free. But my case is not severe enough for ECT - as considered by NHS.
Prozac was working well except I had problems with headaches and anger control. There seems to be three sides to my depression: anxiety, anger and anhedonia. Different drugs affect these different aspects to varying degrees. So far Mirtazapine has been best in helping anxiety and sleeping problems, Effexor in helping with irritability and anger management, but nothing seems to be able to shift this anhedonia which is getting worse by age. It is really painful, it feels like an emptiness screaming inside my head. It stops me from relating to people. I am continuously and desperately bored. I get so frustrated that I develop headaches which go one for two weeks or more. Anhedonia was the main reason why my marriage broke down. I look almost psychotically calm on the outside which gives people the impression that I am OK. But on the inside I turning and twisting with boredom. I can’t stand other people’s company. I wake up in the morning and most days I take a sleeping pill right after breakfast and go back to bed or just stay in bed and keep my eyes closed hating the thought of getting up. I can go on for ten fifteen hours with my eye closed, during which time I have no control over my thoughts. They just race around completely disordered and I never remember what I was thinking three seconds before.
On days when I feel better I try to keep busy but it is very difficult because I take no pleasure in anything I do.
Now I understand why schizophrenics stop taking their medication from time to time. Some times all that pain is somehow worth it, just to feel something other than frustration.
I think the worst part of it is that because the anger and anxiety are gone people just don’t realize how painful it is.
Posted by Rob Hallett on July 10, 2002, at 15:15:53
In reply to Re: Mirtazapine Effexor, posted by fairnymph on July 7, 2002, at 12:10:48
> What pyschiatric disorder do you suffer from, depression? Or more?
>
> Have you considered gving wellbutrin a try?
>
> Also, regarding Effexor, 10 days of treatment (especially considering you have to taper onto it, or at least you should) should not be nearly enough for you to start noticing any improvement. I would think you would need at least 3 weeks, if not even longer...
>
> You can't give Effexor more time, though, because you can't afford it?
>
> You say prozac was working well for you for a while, have you considered other SSRIs?
>
> good luck with all this....keep working at it!
>
> ~fairnymphI'm currently on 450mg Effexor combined with 45mg Mitazapine daily,the former taken in a morning and the latter at night. Doses of Effexor up to 600mg are now being used in the UK to impact on intractable mood disorders, even though Effexors licence is only up to 375mg. Thus no alternative,but higher doses of Effexor. When I increased the mirtazapine above 45mg(in combination), it produced quite marked sedation! With Effexor at this level for 2 months now,my mood has lifted overall quite a bit, but I'm still getting periods of 2-4 days when I'm back to a state of no energy/depression/impaired thinking.
Rob
Posted by suji on July 10, 2002, at 15:43:39
In reply to Re: Mirtazapine Effexor, posted by babak on July 10, 2002, at 2:21:29
Oh, I so sympathize with you about getting up and taking a sleeping pill and going back to bed.... I also have done this for many, many days, even weeks...and I know how weird it is just to lay there and watch your mind wander about as the hours go by....it's almost like being in suspended animation.
I'm wondering if you've tried any of the other types of anti-depressants (MAOI's, trycyclics, etc.)....? I have had some help especially from MAOI's (in spite of the diet restrictions and some of the side-effects). I have also benefitted from Dexadrine (up to 40 mg/day--time-release spansules). At the moment I'm taking Dexadrine (as above), 1mg of Ativan (for anxiety unrelated to Dex.), and 5mg of Paxil (which I'm trying to come off since I haven't found it to be useful).
My heart goes out to you--I have definitely 'been there and done that'.... There is hope, though. Different meds may help...and whenever possible/appropriate let people know you're NOT okay, even if you look as though you are...
There IS help and it comes in all sorts of shapes and disguises....the fact that you're reaching out on this site is,in and of itself, a positive sign!
Stay in touch, and take care,
suji
Posted by babak on July 12, 2002, at 13:50:52
In reply to Re: Mirtazapine Effexor, posted by Rob Hallett on July 10, 2002, at 15:15:53
> I'm currently on 450mg Effexor combined with 45mg Mitazapine daily,the former taken in a morning and the latter at night. Doses of Effexor up to 600mg are now being used in the UK to impact on intractable mood disorders, even though Effexors licence is only up to 375mg. Thus no alternative,but higher doses of Effexor. When I increased the mirtazapine above 45mg(in combination), it produced quite marked sedation! With Effexor at this level for 2 months now,my mood has lifted overall quite a bit, but I'm still getting periods of 2-4 days when I'm back to a state of no energy/depression/impaired thinking.
> Rob
RobI would kill to have only period of 4 days of bad times. My doc. has asked me to keep a diary of my moods and rate them between 1 to 5, 5 being awful and 1 being fantastic. In the last two months I have never past 4 with most days being 5 and that is only becasue there is no 6.
More over, apart from the four weeks "honeymoon" I had with Mirtazapine my mood has't rated better that 3 in the last 12 years.
Posted by babak on July 12, 2002, at 20:11:18
In reply to Re: Mirtazapine Effexor » babak, posted by suji on July 10, 2002, at 15:43:39
> Oh, I so sympathize with you about getting up and taking a sleeping pill and going back to bed.... I also have done this for many, many days, even weeks...and I know how weird it is just to lay there and watch your mind wander about as the hours go by....it's almost like being in suspended animation.
>
> I'm wondering if you've tried any of the other types of anti-depressants (MAOI's, trycyclics, etc.)....? I have had some help especially from MAOI's (in spite of the diet restrictions and some of the side-effects). I have also benefitted from Dexadrine (up to 40 mg/day--time-release spansules). At the moment I'm taking Dexadrine (as above), 1mg of Ativan (for anxiety unrelated to Dex.), and 5mg of Paxil (which I'm trying to come off since I haven't found it to be useful).
>
> My heart goes out to you--I have definitely 'been there and done that'.... There is hope, though. Different meds may help...and whenever possible/appropriate let people know you're NOT okay, even if you look as though you are...
>
> There IS help and it comes in all sorts of shapes and disguises....the fact that you're reaching out on this site is,in and of itself, a positive sign!
>
> Stay in touch, and take care,
>
> sujiSuji
Thank you for your kind words.
I am at my wit’s end. I have had the most horrendous headaches in 24 days of the last 27 days. It doesn’t even respond to 300mg Dihydrocodeine which I have had to obtain through a dealer since my “doctor” is not prepared to prescribe anything stronger than the over the counter painkillers. I am certain that if I weren’t so emotionally lobotomised by these drugs I would have committed suicide by now.
I am reluctant about MAOI's option because that would mean two weeks wash out. I have had very bad experinces with Effexor discontinuation and in my current state I am afraid that it would be just too much. But I would be prepared to try anything else as long as it doesn’t require a complete wash out.
Could it be that the combination of Mirtazapine+Effexor and Codeine are cancelling each other out? I read somewhere that they use Naltrexone (an Opioid antagonist) to counteract antidepressant poop out.
I am just so confused.
Babak
Posted by suji on July 12, 2002, at 23:30:37
In reply to Re: Mirtazapine Effexor, posted by babak on July 12, 2002, at 20:11:18
I don't think these drugs would be likely to cancel each other out--but I can well imagine you being in a very painful place from possible interactions.... And I certainly understand about the washout problem...sometimes it's just not possible to go for any length of time with nothing.... Something ocurred to me, though, and that is the question of whether you might actually be better off slowly tapering down or off these medications, which don't seem to be doing you much good anyway. Of course, it's only advisable to do this with a supportive doc who can monitor what's going on...is a short hospital stay an option? Then you could get your meds stabilized in a safe environment (relatively speaking, that is).
Whatever you decide though, try being kind to yourself...try to recall even a tiny moment of pleasure, buy/find something that will awaken your senses like incense, flowers or a plant, a new music CD, even new, 100% cotton sheets for your bed--anything to stop staring at the TV, which only ever seems to make me feel much worse about myself.
Somehow, at some point, we have to just accept that our lives are worth something...even if we haven't a clue what it is...and go on from there. You might start by treating yourself to some little thing...no matter how tiny, as long as it touches some long-forgotten chord of joy. I promise you, it's there--your purpose for today is to begin to nurture it.
Be brave--you really and truly are worth it...
:=) (=:
suji
Posted by babak on July 19, 2002, at 16:49:34
In reply to Re: Mirtazapine Effexor » babak, posted by suji on July 12, 2002, at 23:30:37
Thanks again suji, for your support but the problem with anhedonia is that it just doesn't allow you enjoy anything like music or shopping. I even feel like a stranger towards my daughter. Intellectually I know I love her, I am even aware that a piece of music is beautiful but emotionally it is just not there, even food tastes like cardboard. If I feel anything apart from frustration is a sense loss for not being able to enjoy things like food, music, sunshine, clean sheets and such like.
Finally after 23 consecutive days of headache I went to see my GP (my psychiatrist is on holiday) and he put me on a small dose of Amithriptyline. The headache is better although it is still there and my whole body aches as if I have been in a wresting match. On top that I think it must be interfering with my other medication because I feel a very nasty restlessness when I go to bed. I can’t stay in one position for more that two or three minutes. I feel really tired but I just can’t sleep. I think I just pass out in the end.
If I only know why Mirtazapine stopped working and how I can get it to kick in again. I have seen the tips on Naltrexone reinstating the effects of SSRIs. Will it work with Mirtazapine too?
Anyone please,
Babak
This is the end of the thread.
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